Where a contagious case exists in a household, prophylactic meas ures offer a better prospect of success in preventing the spread of in fection, than in attempting to actually guard against it. The physician may obtain splendid results in such a ease by the strict enforcement of hygienic measures of various kinds. Briefly summarized, these rules depend upon the rigid isolation of the sick from the well, which is best accomplished by the removal of the patient to a hospital or sanatorium: the complete shutting off of the sick room, the nurse, and the kitchen used by the patient: disinfection and the careful handling of the ex creta of the patient; and, after the disease has run its course, disinfec tion of all the effects, toys, linen, dishes, of everything, in fact, which may have come in contact with the patient.
Particular care must be taken in scarlet fever, diphtheria, and whooping-cough. Scarlet fever is contagious through the desquama tion of the hands, for weeks after the actual symptoms have disappeared, and the parents should be warned of the possibility of conveying the disease by mere handshaking, or in the course of play. As it is impossi ble to prevent children from playing with their fellows after a prolonged period of isolation, and as they may be contagious in no other way ex cept through the hands, it is obvious that the wearing of easily washed and easily disinfected white cotton gloves would prevent the transmission of the disease.
We know that in diphtheria, long after the local process has disap peared, virulent diphtheria bacilli may be found in the mouth. The possibility of contagion exists for a longer period than that during which we are in the habit of isolating the cases. An effort must therefore be made, even after the usual isolation period of six weeks, to prevent infection by the mouth through contact. This may be accomplished in groat measure by forbidding kissing.
The same is true also of whooping-cough, which may be contagious for a long time, being transmitted through the mucus from the nose and throat. As is usually the case with infectious diseases in children, this affection is ordinarily transmitted during play. An endeavor should therefore be made to keep these children from coming in contact with healthy ones as long as possible. It is just such an infectious disease as whooping-cough which can most readily be prevented from spreading by carrying out the principles of extreme cleanliness. Mucus from the nose and throat of children readily becomes attached to the fingers, or is conveyed to them from the handkerchief, or.is wiped off upon the
clothes. It is therefore to he recommended that the children wear easily changed, washable garments, or that the clothes be protected by aprons. Aseptic handkerchiefs are worth while, as they may be burnt up immediately after having been used. The hands should be washed immediately after every paroxysm of coughing. A child suffering from whooping-cough should avoid those places where children are in the he hit of congregating, such as open play grounds, or bathing places. which are likely to be sought by children who are recuperating. Not infrequently a popular summer resort or bathing place is selected to which to send a child suffering from whooping-cough, under the erroneous impression that the disease will be cured through a change of air.
Infectious diseases do not belong only to the period before the child goes to school, since the period of school years claims further victims from among those children who have been previously shielded from contagion. As the school itself is very often the medium for spread ing disease, the physician must, at the beginning of an illness accom panied by any fever, absolutely exclude all infectious diseases before allowing the child to return to school. He should endeavor to impress upon the parents that they should never take it upon themselves to pass judgment upon a case, and that even where the manifestations are mild, it is important to consult a physician. It is common enough to find that influenza, varicella, and the prodromal stage of measles are unrecognized, the children are permitted to attend school, and the infection is spread among the pupils. The general practitioner can do much to further the cause of the prophylaxis of infectious diseases by instructing the families, to their great benefit.
There rests with the physician an important duty in the way of prophylaxis, in the prevention of the of the infectious diseases. Even though lie stands helpless in the face of ninny complications which occur at the beginning or during the course of the disease, lie is never theless justified in anticipating certain troubles (as severe itmemia, or tuberculosis) after such diseases as whooping-cough and measles. These can often he avoided through good nourishment, careful observation, and the application of all the hygienic measures at our disposal, particularly fresh air and change of climate. Even for the poorest, in Germany there is ample provision in this regard to he found in the recuperating and cure places and the woods schools.